Does Uncle John have Viral Hepatitis?

•Basic overview: It is an inflammation of the liver caused by certain viruses.•Causative agents: Hepatitis A, B, C, D and E virus, Epstein Barr virus and even Varicella Zoster virus.•Most likely suspect: Hepatitis B

Why Hepatitis B?•Main form of transmission is through sex, blood transfusions and IV drug usage. (which leaves us Hep A (predominantly fecal-oral) and B)•Fitting incubation period, 6 weeks to 6 months. (only Hep B as the rest are relatively fast around 2-4months)•China is a high prevalence area, as is SEA (assuming Uncle John is local).

Signs and Symptoms:Abdominal painDark urine (sign of liver failure) UJFeverJoint pain / body achesCirrhosis UJUnusually light-colored stool (sign of liver failure leading to bile production impediment)Unexplained fatigue that persists for weeks or months. UJSkin RashEnlarged Liver which manifests as a constant discomfort on the right side of the belly under the rib cage and general fullness. Bloated / swollen stomach. UJGastrointestinal symptoms such as loss of appetite, nausea, and vomiting. UJYellowing of your skin and the whites of your eyes (jaundice) UJThe immune system usually manages to fight off Hep B infections within a few months, developing an immunity that lasts a lifetime. But, if the infection exceeds six months, considered a carrier, even if no symptoms.

How about Alcoholic Liver Cirrhosis?• History of chronic alcoholism • “For many years during bachelor days...every

evening...to have his drinks...” • “...drinking excessively in recent years...”• Between 8% to 20% of heavy drinkers develop cirrhosis

(Robbins)• Estimated that 15-20 years of excessive drinking are

necessary to develop alcoholic cirrhosis, while (Robbins) Alcoholic Liver Disease:1. Hepatic steatosis (retention of lipid within hepatocytes)2. Alcoholic Hepatitis 3. Fibrosis & cirrhosis

Sign and symptoms of alcoholic liver disease:Digestive symptoms include:Pain and swelling in the abdomenDecreased appetite and weight loss UJ Nausea and vomitingFatigue UJDry mouth and increased thirstBleeding from enlarged veins in the walls of the lower part of the esophagus (tube that connects your throat to your stomach)

Skin problems such as:Yellow color in the skin, mucus membranes, or eyes (jaundice) UJSmall, red spider-like veins on the skin (spider telangiectasia or spider angioma)Very dark or pale skinRedness on the feet or handsItching

Brain and nervous system symptoms include:Problems with thinking, memory, and mood UJFainting and lightheadednessNumbness in legs and feet

http://www.nlm.nih.gov/medlineplus/ency/article/000281.htm

Spider telangiectasia-Type of swollen vessel found beneath skin, common and benign in 10-15% of healthy adults and children

- >3 spider angiomas are abnormal, or may be a sign of liver disease.

Provisional Diagnosis